The United States is in the midst of an opioid crisis, with more than 130 people dying each day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2018a). Given the recent spike in overdose deaths associated with highly potent synthetic opioids (i.e., fentanyl), there are few signs of the crisis abating (CDC, 2018a). Compared to other age groups, the prevalence of both heroin and prescription opioid use is particularly elevated among young adults (Sharma, Bruner, Barnett, & Fishman, 2016). While there is a large body of evidence demonstrating the effectiveness of substance use treatment in general, only 40-60% of individuals remain abstinent in the year following treatment (McLellan, Lewis, O’Brien, & Klebler, 2000). Less attention has been given to the process of treatment, making it challenging to determine what works and what needs improvement. This information is necessary in developing a comprehensive understanding of the treatment process, which in turn, will inform treatment decisions and improve client outcomes. The current study adds to existing literature by assessing during-treatment change on four proximal outcomes measuring substance-related cognitions (i.e., abstinence self-efficacy and commitment to sobriety) and self-concept (i.e., internalized shame and self-compassion). It was hypothesized that participants would demonstrate significant changes in the favorable direction on all four proximal outcomes. A sample comprised of primarily young adults with opioid use disorders attending short-term residential substance use treatment were enrolled in a naturalistic longitudinal study and assessed at intake, mid-treatment, and discharge. Individual growth curve models were used to examine change over time at both the aggregate and individual levels on the four proximal outcomes. Several potential moderating influences (e.g., demographic information, substance use history, mental health symptoms) were explored to better understand initial status and responses to treatment. Results revealed significant changes in the expected direction on all four proximal outcomes. In addition, several variables emerged as significant predictors of initial status and rates of change. These results provide further evidence that residential substance use treatment is not only a viable option in reducing substance use, but also impacts other important outcomes relevant to clients’ functioning and overall well-being.

Indiana University-Purdue University Indianapolis (IUPUI) / Opioid misuse and addiction has been widely identified as a public health problem, contributing substantially to the nation’s morbidity and mortality. Over the past two decades, misuse of prescription opioids pain relievers has substantially increased; heroin use has resurged; and, more recently, abuse of high-potency synthetic opioids such as fentanyl have fueled the epidemic. Nearly 12 million Americans (or 4.4%) aged 12 and older misused some type of opioid (prescribed or illegal) in the past year. Furthermore, the percentage of substance use treatment admissions attributable to opioids nearly doubled in the U.S., from 20.8% in 2000 to 40.5% in 2015. The purpose of this dissertation research was to investigate associations between prescription pain reliever use and subsequent negative health outcomes, including opioid misuse or addiction, and neonatal abstinence syndrome. This research focused on three specific aims: Specific Aim #1: Examine heroin use among Indiana’s substance use treatment population to measure the extent, trends, and patterns of use, as well as to assess the relationship between prescription opioids and subsequent heroin use; Specific Aim #2: Analyze 2014 INSPECT (Indiana’s prescription drug monitoring program) data to identify factors that increase patients’ likelihood to engage in opioidrelated risk behaviors; and Specific Aim #3: Review U.S. trends in neonatal abstinence syndrome (NAS) incidence from 2008-2014, measure regional variability, and identify personal and environmental risk factors associated with NAS. / 2020-08-09

Indiana University-Purdue University Indianapolis (IUPUI) / The United States is experiencing a severe opioid use epidemic with more than 2 million people currently suffering from opioid use disorder (OUD), of which, over 1 million need treatment. Opioid treatment programs (OTPs) are evidence-based modality providing comprehensive care to individuals experiencing OUD. OTPs provide counseling, medical assessments, and medication-assisted treatment, which decrease the use of illicit opioids, reduce associated deaths, criminality, and improve the psychosocial wellbeing of its patients. However, OTPs have been extensively regulated at the federal, state, and local levels with little consistency and varying degrees of enforcement across the country, particularly at the state level, creating a “regulatory fog”. This complex regulatory environment has made it challenging to study new or changing regulations and their impact on health outcomes. In order to better understand the variation of OTP regulation, this dissertation: (1) employs public health law research methods to map the entire landscape of state-level regulation of OTPs and associated state characteristics in effect on January 1, 2017; (2) examine how state-level regulations affect the delivery of care from the perspective of OTP administrators through key-information interviews; and (3) examines associations between regulatory burden and related health outcomes of individuals experiencing OUD, by state.

Indiana University-Purdue University Indianapolis (IUPUI) / Pregnant and postpartum women with substance use disorders (SUDs) are likely to experience adverse health care encounters that contribute to poor health outcomes for them and their infants. The purpose of this dissertation is to describe the health care encounters of pregnant and postpartum women with SUDs. This dissertation includes two studies. The first study is a metasynthesis of published qualitative studies using a metasummary approach to classify the types of health care encounters experienced by pregnant and postpartum women with SUDs. A taxonomy of health care encounters was developed. Five types of adverse encounters were identified and labeled as (a) judgmental, (b) disparaging, (c) scrutinizing, (d) disempowering, and (e) deficient care. Three types of beneficial encounters were identified and labeled as (a) recovery-based, (b) accepting, and (c) effective care. The second study was a qualitative descriptive study conducted to describe factors that influence the formation of trusting relationships between maternity nurses and pregnant and postpartum women with SUDs. Interviews with 15 maternity nurses and 10 pregnant and postpartum women with SUDs were conducted. Content analysis of the participant narratives revealed a number of characteristics of maternity nurses and pregnant and postpartum women with SUDs that helped or hindered trusting relationships. Six characteristics of maternity nurses were identified and labeled as (a) rapport-building with women, (b) demeanor toward women, (c) provision of care, (d) provision of information, (e) attitude toward substance use, and (f) addiction expertise. Five characteristics of the women were identified and labeled as (a) engagement with nurses, (b) demeanor toward nurses, (c) acceptance of care, (d) investment in recovery, and (e) bonding with infant. Adverse encounters were often associated with provider stigma related to substance use during pregnancy and limited provider knowledge related to addiction. The findings will contribute to the development of strategies to improve the health care encounters of this population by promoting stigma awareness and communication skills training.

Indiana University-Purdue University Indianapolis (IUPUI) / Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of affect-based factors, few other mechanisms have been examined in the literature. One potential candidate is locus of control (LOC). LOC is a learning processes that involves the degree to which an individual attributes rewards as resulting from their own control (internal LOC) versus outside control (external LOC). There is evidence that exposure to stressors is associated with LOC, with a separate body of literature linking LOC with substance use. Thus, it is plausible that LOC may be a mechanism underlying the relationship between racial discrimination and substance use. Additionally, there is evidence that depression is related to LOC. Thus, the relationship between racial discrimination, locus of control, and substance use may also be serially mediated through depressive symptoms. The current study investigated these two pathways among 503 racial/ethnic minority adults aged 18-35 who completed an online questionnaire that included measures on racial discrimination related stress, locus of control, depressive symptoms, and substance use. Results indicated a significant indirect effect of racial discrimination related stress through external locus of control, specifically the chance orientation, on substance use. Moreover, for both domains of external locus of control (i.e., chance and powerful others) a significant serial indirect effect was found through depressive symptoms within the racial discrimination-substance use pathway among racial/ethnic minority adults. These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming for this population

Substance use disorders (SUD) are among the most significant worldwide public health challenges. Isolation and separation are some of the more common indicators of SUD. Even though various music therapy interventions are used to address clinical goals when working with clients with SUD, voicework, specifically, has not been abundantly researched with this client group. Research has shown that the use of the voice has the ability to turn isolation into connection. This qualitative study therefore examined whether voicework with this client group could facilitate connection. Seven clients participated in six group music therapy sessions held at a halfway house over three weeks. The sessions as well as the one focus group were transcribed, and thick descriptions were written of musical excerpts; all were then analysed thematically. From the data, the following four themes were developed: (1) multiple forms of connection were afforded through voicework in music therapy; (2) music therapy offered multiple opportunities for facilitating connection; (3) particular techniques were useful for enhancing connection; (4) a music therapy process, centred around voicework, offered participants an experience in which they could reflect on connection and disconnection. The findings suggest that voicework can be a useful intervention within music therapy to create opportunities for connection to both the self and other. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2021. / Music / MMus (Music Therapy) / Unrestricted

Exercise training for clients at out-patient drug rehabilitation centers likely helps with coping skills. However, a better examination of the mechanisms producing changes may help identify effective interventions. PURPOSE: To test the effect of a vigorous exercise prescription on drug abstinence in voluntary rehabilitation patients. METHODS: 25 surveyed participants in a male drug treatment program underwent a 12-week minimum training program. The program included moderate-rigorous exercise and psychotherapy. Three days per week all subjects participated in EP for 90 minutes. Subjects also participated in ABIT 3 days per week where each session lasted 2 hours. Subjects also participated in ESM which ran for 90 minutes 5 days per week. Within each week, program participants also completed between 2-3 hours of psychotherapy (individual and/or group) per day, varying depending on level of care and phase of the treatment process. Exercise performance and adherence, sobriety and relapse rates, and emotional coping skills were collected. RESULTS: Subjects experienced frequent relapse (5±8 occurrences) prior to admission; however, 84% were currently sober on completion of the program, 8% relapsed during treatment, and 36% relapsed after treatment. The longest duration of sobriety a subject achieved was 273±111 days. Post-treatment survey results indicate 84% of subjects still exercised regularly, 68% continued to practice yoga or meditation, and 60% followed a diet that required disciplined awareness. Bench press max improved significantly throughout the program (39%; p<.001), as did squat (55% improvement; p<0.001) and deadlift (69.8%; p<0.001). On completion of the survey 91% of patients who exercised regularly were sober; 50% of patients who did not engage in regular exercise were sober on completion of the program (P=0.043). Owing to a small sample of patients who relapsed during treatment (N=2), the difference in exercisers who relapsed during treatment (5%) and non-exercisers who relapsed (25%) was not significant (P=0.171). Twenty-nine percent of exercisers relapsed after treatment; 75% of non-exercisers relapsed after treatment (P=0.076). The odds of managing adverse emotional states when they arose increased 20-fold among subjects who reported regular participation in exercise (Nagelkerke R2=0.333; P=0.036). Similarly, each additional day per week that a patient practiced yoga predicted a 20-day increase in duration of sobriety (R2=0.227; P=0.016). CONCLUSION: Exercise training exerts a statistically significant positive effect for sobriety and coping skills within a population that previously struggled with perpetual relapse.

No description available.

Background: Sedatives and hypnotics are substances to calm or relieve anxiety and to induce sleep. Long term prescription of benzodiazepines/Z-drugs may lead to the development of tolerance and the need to increase the dose. It is important to be aware of the risks of uncontrolled use of these drugs, such as harmful interactions with other substances, side effects and potential for abuse or addiction. Aim: The aim of this research was to describe abuse of sedatives and hypnotics from the user's perspective, to focus on circumstances leading to drug abuse, to describe beginning and course of the use of these drugs and self-awareness of the problem. The aim was also to describe the current state of users and their needs. Sample: The research sample consisted of 6 participants, of which 4 women and 2 men currently or recently using sedatives and hypnotics (specifically benzodiazepines/Z-drugs). Methods: Data were collected through a qualitative approach using a semi-structured interview. Interviews were conducted, rewritten into protocol summary, further analysed using thematic analysis, modified using open and axial coding and categorization methods. Results: Respondents may have misused sedatives and hypnotics to self-medicate symptoms. These drugs were prescribed for the first time with...

No description available.